I am often asked if artificial sweeteners are safer than regular sugar. As these substances have only recently been around, the research regarding their long-term effects is limited but growing.
Artificial sweeteners are ubiquitous. Many will believe they are choosing the less dangerous version, “zero,” of their preferred soft drink, but is that true?
In this article, I will discuss the research behind the consumption of these sweeteners and the risk of stroke and dementia.
Researchers published a study in which they followed 2,888 patients over the age of 45 to see if they developed a stroke. They similarly followed 1,484 patients over the age of 60 for their development of dementia. They examined “recent consumption” and cumulative consumption of sugar and artificially sweetened drinks by taking multiple exams of the patients.
Artificially sweetened drinks included saccharin, acesulfame, aspartame, neotame and sucralose. They used a questionnaire at exams 5, 6, and 7. These examinations were conducted from 1991 to 2001. They started watching for the development of stroke or dementia starting at examination 7 and followed for 10 years. They also compared these participants with those who drank sugar-sweetened drinks, including soft drinks and fruit juices. They were asked how frequently they consumed one glass, bottle or can of each sugary beverage item, on average, across the previous year.
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In short, the results revealed a higher risk of stroke, dementia and Alzheimer’s disease in individuals with a higher intake of artificial sweeteners. They compared with sugar-sweetened beverages, which were not associated with an increased risk of stroke or dementia.
This study, published in 2017, was unique in that until that time, there was no other study linking daily use of artificially sweetened drinks to an increased risk of dementia of all causes, including Alzheimer’s.
However, each study has limitations. Participants were asked to recall their intake over an entire year.
Many experienced physicians know that patients often underestimate their use of a substance they know will be scrutinized. Furthermore, it may be difficult for such patients to recall exact details.
Additionally, artificially sweetened beverages are also more likely to be consumed by patients who already have diabetes, which is noted to be another risk factor for dementia on its own. Participants were selected from the Framingham Heart Study Offspring Cohort, mainly of European descent, limiting the inclusion and possible applicability to minorities. Also, because these researchers followed and observed these patients, they cannot claim to have established a direct cause and effect of artificial sweetener use and the increased risk of stroke and dementia. The study allows us to conclude a correlation at best.
In a prior editorial, I mentioned the amount of research connecting stroke with the increased risk of developing dementia later in life. In July of 2024, The Lancet Commission on Dementia Prevention, Intervention and Care detailed 14 risk factors that impact individual risk for dementia.
Three of those factors — diabetes mellitus, hypertension and high LDL — are correlated with stroke. Sugar has been implicated in the development of diabetes and has been limited to increased caloric intake with the resulting development of cardiac disease. An increased risk of cardiac disease inevitably leads to an increased risk of stroke. Multiple strokes over time can cause multi-infarct dementia, which is increasingly diagnosed in the population.
The research evaluating the potential effects of artificial sweeteners is vast and ongoing. Our understanding continues to evolve on the possible detrimental effects of these poorly understood ingredients. It may be best to start taking note of which drinks you consume and what ingredients they contain.
Dr. Naznin Jamal is a Jefferson Regional Medical Center hospitalist.